Registration Form

Summer Omics
& Bioinformatics Workshop
Registration
Please complete, sign and return this form to Dr. YuanYu (Kent) Lee to register for the 2015 5th CEPA
Summer Omics and Bioinformatics Workshop.
Both registration form and payment must be received by Tuesday 30 June 2015. Confirmation of
registration will be sent by email once payment has been received.
I hereby register for the Summer Proteomics Workshop at CSULB, 7th – 9th July 2015
FULL NAME
Title ____________
First Name ___________________________________________________________________
Last Name ___________________________________________________________________
Suffix _____________
ADDRESS
Street Address 1 ______________________________________________________________
Street Address 2 ______________________________________________________________
City ______________________________________________________________
State ______________
Zip code _______________
E-Mail Address _____________________________________________________________
Phone Number _____________________________________________________________
Fax Number _____________________________________________________________
PAYMENT INFORMATION
Lunch is provided each day of the workshop! Please mark the appropriate box:
□ CSULB employee/student: $100
□ Other CSUs rate – please indicate campus: $150
□ Others rate – please indicate organization/campus: $250
Non-refundable for cancellations.
To facilitate our planning, please fill in the following:
Any dietary requirements (please provide here)?__________________________________
NEARBY ACCOMMODATIONS
Please check website (http://www.csulb.edu/divisions/students/housing/hotels.htm) for hotels
DRIVING DIRECTIONS AND PARKING INFORMATION
Please check the website (http://www.csulb.edu/maps/) for directions.
Please check the website
(http://www.foundation.csulb.edu/departments/property/documents/parklot.htm or
http://daf.csulb.edu/offices/ppfm/parking/) for parking.
Name
Signature
Date
Please complete and return this form by email (subject: Omics Workshop 2015)
to: [email protected]
Checks payable to CSULB Research Foundation
Questions?:
Dr. YuanYu (Kent) Lee
Phone: (562) 985-2469 or (562) 912-3436
IIRMES, College of Natural Sciences and Mathematics
California State University Long Beach,
1250 Bellflower Blvd, Long Beach, CA 90840-4501